What to Have Ready for an Urgent Oncology Call

If something is clearly wrong, dial first. You do not need a tidy list before you are allowed to call. NCI's booklet Chemotherapy and You says it directly: "Call your doctor right away if you think you have an infection. Even if it's on the weekend or in the middle of the night, you still need to call."

Everything below makes the call shorter. Most of it you can gather while the phone rings.

Under medical review. This page describes urgent decisions and is held back from public search until a clinician has checked the wording.

A fever here means about 100.4–100.5 °F (38 °C) or higher. The published wordings differ slightly:

• National Cancer Institute: a "fever of 100.5 °F (38 °C) or higher" — its printed 100.5 °F is a conversion slip, since 38 °C is 100.4 °F; act at 100.4 °F (38 °C) — listed as a sign of infection to report to your health care team.
• American Cancer Society: "For people with cancer, a fever is defined as a temperature of 100.4 °F (38 °C) or higher for at least one hour."
• MedlinePlus (NIH): a "fever of 100.4 °F (38 °C) or higher."
• The clinical definition of febrile neutropenia: "a single oral temperature greater than or equal to 101 F (38.3 C) or a temperature greater than or equal to 100.4 F (38 C) for at least an hour."

38.0 °C is exactly 100.4 °F, so NCI's 100.5 °F is a rounding of the same reading. NCI says to call your health care team if you have signs of an infection, because infections during cancer treatment can be life threatening and require urgent medical attention. Chemotherapy and You notes the number can vary, and ACS says to "ask your cancer care team what temperature they consider to be a fever. It might be different depending on your situation, but 100.4 °F (38 °C) is often used." Ask which number your own team wants you to use — theirs outranks any published one — and if you are between the numbers and unsure, call anyway. No oncology service minds being called.

Do not bring the fever down before you call. NCI says to talk with your doctor or nurse before taking medicine — even aspirin, acetaminophen (such as Tylenol), or ibuprofen (such as Advil) — for a fever. Take the reading, note the time, and give the number on the call.

• Full name and date of birth.
• Cancer type, current treatment, and date of the last dose.
• The temperature you just took, and how you took it.
• What changed, when it started, and whether it is getting worse.
• Medicines and doses, anything taken in the last 24 hours, and allergies.
• What has been eaten and drunk today, and when they last urinated.
• Which pharmacy is open right now.
• The hospital you would go to if you are sent in.
• A pen. You will be given instructions and you will not remember them.

NCI's caregiver booklet suggests keeping a notebook of medical information, including dates of procedures and tests, and a list of medicine names, doses, and how often they are taken. If that notebook exists, this call is mostly reading it aloud.

Nurses triage on specifics. Say "temperature 101.2 at 9 p.m., shaking started an hour ago" rather than "not doing great." Give a number wherever one exists: episodes of vomiting or loose stools, hours without urinating, days since a bowel movement, pain out of 10. Say what you already tried and what happened.

Say plainly if the plan is not workable at home tonight — no driver, no open pharmacy, stairs that cannot be managed. That is clinical information, not a complaint.

• What exactly should we do in the next few hours?
• What would mean calling back sooner, or going in?
• Who is doing the next step, and when?
• Who did I just speak to, and when should I expect follow-up?

The American Cancer Society's guidance for signs of infection is to call your cancer care team, or get medical attention right away. It lists: fever or lower body temperature than normal; chills or sweats; cold, clammy, or pale skin; cough or trouble breathing; new or worse confusion; feeling dizzy, lightheaded, or falling down; chest pain; not able to get out of bed for more than 24 hours; and not having to pee or peeing only very little amounts that are dark orange or brown.

ACS lists the signs of septic shock, the most severe stage of sepsis, as a fast heart rate, low blood pressure, confusion, pale, cold, or clammy skin, nausea, and breathing problems. ACS also says sepsis can turn into septic shock quickly. Do not wait for a callback if you see those signs. If your team has already told you to go straight to the emergency department for fever, go, and tell the front desk the person is on cancer treatment.

NCI's instruction is to find out how to contact your doctor or nurse in an emergency, including who to call and where to go, and to enter important phone numbers in your phone so they are there when you need them. Daytime and after-hours lines often differ.

Creating a cancer symptom and call plan covers writing thresholds down in advance; managing cancer symptoms overnight and on weekends covers what cannot wait until Monday.

This page cannot diagnose a symptom or set an emergency threshold for you. Follow your team's written instructions, and do not change prescribed medicines, treatment, activity limits, or devices on your own.

If someone may be in immediate danger, contact local emergency services. For thoughts of suicide or self-harm in the United States, call or text 988; elsewhere, use the local crisis service.

• National Cancer Institute, Chemotherapy and You: https://www.cancer.gov/publications/patient-education/chemotherapy-and-you.pdf
• National Cancer Institute, Infection and Neutropenia During Cancer Treatment: https://www.cancer.gov/about-cancer/treatment/side-effects/infection
• National Cancer Institute, When Someone You Love Is Being Treated for Cancer: https://www.cancer.gov/publications/patient-education/when-someone-you-love-is-treated.pdf
• American Cancer Society, Managing Infections and Sepsis: https://www.cancer.org/cancer/managing-cancer/side-effects/infections/managing-infections-and-sepsis.html
• American Cancer Society, Fevers: https://www.cancer.org/cancer/managing-cancer/side-effects/infections/fever.html
• MedlinePlus, Cancer treatment - preventing infection: https://medlineplus.gov/ency/patientinstructions/000913.htm
• StatPearls (NCBI Bookshelf), Febrile Neutropenia: https://www.ncbi.nlm.nih.gov/books/NBK541102/